当前位置： SCI文献检索 > BMC Family Practice期刊下所有文献 > Deprescribing medication in very elderly patients with multimorbidity: the view of Dutch GPs. A qualitative study.

Deprescribing medication in very elderly patients with multimorbidity: the view of Dutch GPs. A qualitative study.

Abstract：

BACKGROUND:Elderly patients with multimorbidity who are treated according to guidelines use a large number of drugs. This number of drugs increases the risk of adverse drug events (ADEs). Stopping medication may relieve these effects, and thereby improve the patient's wellbeing. To facilitate management of polypharmacy expert-driven instruments have been developed, sofar with little effect on the patient's quality of life. Recently, much attention has been paid to shared decision-making in general practice, mainly focusing on patient preferences. This study explores how experienced GPs feel about deprescribing medication in older patients with multimorbidity and to what extent they involve patients in these decisions. METHODS:Focusgroups of GPs were used to develop a conceptual framework for understanding and categorizing the GP's view on the subject. Audiotapes were transcribed verbatim and studied by the first and second author. They selected independently relevant textfragments. In a next step they labeled these fragments and sorted them. From these labelled and sorted fragments central themes were extracted. RESULTS:GPs discern symptomatic medication and preventive medication; deprescribing the latter category is seen as more difficult by the GPs due to lack of benefit/risk information for these patients.Factors influencing GPs'deprescribing were beliefs concerning patients (patients have no problem with polypharmacy; patients may interpret a proposal to stop preventive medication as a sign of having been given up on; and confronting the patient with a discussion of life expectancy vs quality of life is 'not done'), guidelines for treatment (GPs feel compelled to prescribe by the present guidelines) and organization of healthcare (collaboration with prescribing medical specialists and dispensing pharmacists. CONCLUSIONS:The GPs' beliefs concerning elderly patients are a barrier to explore patient preferences when reviewing preventive medication. GPs would welcome decision support when dealing with several guidelines for one patient. Explicit rules for collaborating with medical specialists in this field are required. Training in shared decision making could help GPs to elicit patient preferences.

journal_name

BMC Fam Pract

journal_title

BMC family practice

authors

Schuling J,Gebben H,Veehof LJ,Haaijer-Ruskamp FM

doi

10.1186/1471-2296-13-56

subject

Has Abstract

pub_date

2012-07-09 00:00:00

pages

issn

1471-2296

pii

1471-2296-13-56

journal_volume

pub_type

杂志文章

在线工具

Deprescribing medication in very elderly patients with multimorbidity: the view of Dutch GPs. A qualitative study.